BACKGROUND: Eye tumors are moving targets, but there have been no reports of radiation therapy with real-time monitoring. CASE: A 54-year-old woman with metastatic breast cancer was referred for treatment of diplopia due to choroidal metastasis after hippocampal avoiding whole brain radiotherapy. Since visual acuity was preserved and long-term survival was expected, real-time MRI-guided intensity-modulated radiation therapy (36 Gy in 20 fractions) was performed. No adverse events occurred during treatment or during the subsequent one-year follow-up period. The patient's diplopia resolved and no choroidal recurrence was observed during the follow-up period. CONCLUSION: MRI-guided radiation therapy may be a safe and effective treatment for choroidal metastases after hippocampal avoiding whole brain radiotherapy.

• Klíčová slova
• choroidal tumor, image guided radiotherapy, image-guided radiotherapy, intensity-modulated radiation therapy, retinal neoplasms,
• MeSH
• hipokampus MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• nádory choroidey * radioterapie   sekundární   MeSH
• nádory mozku sekundární   radioterapie   MeSH
• nádory prsu * patologie   MeSH
• radioterapie řízená obrazem * MeSH
• radioterapie s modulovanou intenzitou * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The aim of the thesis is to present the case of a patient in whom bilateral calcification of the hydrophilic intraocular lens (IOL) Lentis M+ LS-313 MF30 (Oculentis) has developed. Due to the negative effect on visual functions, explantation and replacement of the artificial lens was necessary in both eyes. Case Report: An overview of the available literature summarized the diagnostics, current examination methods and possibilities of the surgical solution of calcification of the bifocal hydrophilic lens Lentis M+ LS-313 MF30 (Oculentis). The specific solution is described in a case report of a patient in whom calcification of both lenses developed 6 years after implantation of the IOL. In 2015, the patient underwent uncomplicated cataract surgery of both eyes with the implantation of an artificial intraocular lens into the capsule. In September 2021, an 82-year-old man was examined at our outpatient clinic for deterioration of visual acuity and changes in the material of the artificial IOL which were perceptible during a clinical examination, on the recommendation of a local ophthalmologist. Blurred vision predominated. A diagnosis of intraocular lens opacification was confirmed and documented using a Scheimpflug camera (OCULUS Pentacam HR) and anterior OCT (Avanti RTVue XR Optovue,). The patient was indicated for explantation and replacement of the opacified intraocular lens in the left and subsequently in the right eye- The same type of IOL was used for reimplantation with good functional results. Conclusion: Since 2010, multifocal lens implantation has been on an upward trend worldwide. This type of MF IOL has also been used in thousands of implantations. A number of other explantations can be expected in the coming years. The optimal solution is the correct replacement of the calcified IOL with the same construction made of safer hydrophobic material.

• Klíčová slova
• CBS, Calcification, Pentacam, anterior segment OCT, chronic kidney disease, hydrophilic acrylic lens, opacification,
• MeSH
• implantace nitrooční čočky škodlivé účinky   MeSH
• kalcinóza chirurgie   diagnostické zobrazování   MeSH
• lidé MeSH
• melanom * radioterapie   MeSH
• nádory choroidey radioterapie   diagnóza   MeSH
• nádory uvey radioterapie   MeSH
• nitrooční čočky škodlivé účinky   MeSH
• radiační poranění etiologie   diagnóza   chirurgie   MeSH
• radiochirurgie * škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Uveal melanoma is the most common intraocular tumour in adults, it is a form of cancer that affects mostly older adults, as the average age at detection of this tumour is 60 years, but it can occur in any age group with no significant gender difference. However, uveal melanoma is very rare in children compared to the adult population, accounting for 1 % of all cases. In pediatric patients, malignant uveal melanoma is more frequently manifested during puberty, leading to speculation of an association between uveal melanoma and growth hormone levels. Prognostic factors for uveal melanoma include tumour histology, chromosomal abnormalities, tumour size, extrascleral spread and tumour location. Risk factors for uveal melanoma include melanocytosis, neurofibromatosis type 1 and dysplastic naevus syndrome. Some studies point to a significantly lower risk of developing metastases in younger patients, but the prognosis of uveal melanoma in children is not yet fully known. Clinical signs and treatment options for malignant uveal melanoma in children are still under discussion. Differential diagnosis of uveal lesions in children can sometimes be very difficult, as evidenced by following case report in which authors describe a case of choroidal melanoma in a 15-year-old girl.

• Klíčová slova
• body mass index, children, choroidal melanoma, enucleation, metastasis, neoplasm metastasis,
• MeSH
• dítě MeSH
• lidé MeSH
• melanom * diagnóza   MeSH
• mladiství MeSH
• nádory choroidey * MeSH
• nádory kůže * MeSH
• nádory uvey * diagnóza   MeSH
• senioři MeSH
• uveální melanom MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: The finding of the neuroretinal ablation in fovea centralis area on Optic Coherence Tomography (OCT) examination in young men is a typical finding for central serous choroidoretinopathy. This finding may masquerade the presence of the choroidal hemangioma. CASE REPORT: The author presents case reports of two young men, in which, according to the finding of neuroretinal ablation on OCT, the diagnosis of central serous choroidoretinopathy was established. Using following examinations, especially fluorescence angiography, the correct diagnosis of choroidal hemangioma was set. In both patients, the photodynamic therapy with Visudyne was consequently indicated. CONCLUSION: In young patients with slightly decreased visual acuity, neuroretinal ablation finding in the macula on OCT, and without the tendency to spontaneous improvement, it is necessary to keep in the mind the possible presence of choroidal hemangioma.Key words: hemangioma, central serous choroidoretinopathy, misdiagnosis, ablation of the neuroretina, macula, choroid.

• MeSH
• centrální serózní chorioretinopatie diagnóza   farmakoterapie   MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• fluoresceinová angiografie MeSH
• fotochemoterapie MeSH
• fotosenzibilizující látky terapeutické užití   MeSH
• hemangiom diagnóza   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory choroidey diagnóza   farmakoterapie   MeSH
• optická koherentní tomografie MeSH
• porfyriny terapeutické užití   MeSH
• verteporfin MeSH
• zraková ostrost MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• fotosenzibilizující látky MeSH
• porfyriny MeSH
• verteporfin MeSH

INTRODUCTION: Uveal melanoma is the most common primary intraocular tumour in adults in Caucasians and in 75% is arising from choroid. It threatens not only the patients loss of vision and eye, but also 50% of patients after 5-year interval after therapy die due to distant metastases. The treatment of small and medium-sized melanoma are methods preserving eye globe. Almost half of the total number of patients is still unavoidable enucleation. Considerably rarer is indicated exenteration of an orbit. These tumors metastasize only hematogenous, while the most frequent place of localization of distant metastases is the liver. Generalized disease prognosis is poor, and our current treatment options in this stage are ineffective. MATERIAL AND METHODS: Case report of 59 years old patient with choroidal melanoma stage T4 N1 M1 massively infiltrating the orbit. At the time of diagnosis of the primary tumor distant metastases were present. The patient underwent exenteration of the orbit and systemic chemotherapy. DISCUSSION: Although choroidal melanomas with extrascleral extension and infiltration into the orbit have no better prognosis after exenteration of the orbit, surgery is providing us local tumour control. Good cosmetic effect after this mutilating procedure is offered by individually made prosthesis (epithesis). All patients with uveal melanoma require lifelong dispensation, distant metastases may occur even after many years. In the treatment of generalized disease is available systemic chemotherapy and immunotherapy only palliative. The best effect on survival has complete surgical resection of single metastasis. Uveal melanoma has a different genetic profile as cutaneous melanoma. The biological nature of uveal melanoma seems to be the key to determining risk patients, as well as the development of targeted systemic therapy. CONCLUSION: Treatment of patients with generalized large uveal melanoma with extrascleral extension is difficult. A better understanding of biological interest may be the key to the detection of patients at higher risk of distant metastases formation, and to an effective systemic treatment. KEY WORDS: large uveal melanoma, extrascleral extension, orbital exenteration, the treatment of generalized disease.

• MeSH
• eviscerace orbity * MeSH
• lidé středního věku MeSH
• lidé MeSH
• melanom sekundární   chirurgie   MeSH
• nádory choroidey patologie   chirurgie   MeSH
• nádory orbity sekundární   chirurgie   MeSH
• orbita chirurgie   MeSH
• protézy a implantáty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

AIM: Diagnosis and treatment of tumors of the eye is extremely difficul; surgical treatment in advanced stages, when the tumor grows in the orbit, leads to extensive radical surgery of the face. The extent and nature of surgical procedures depends on the nature of the tumor process, in advanced stages is indicated mutilating surgery--exenteration of the orbit. Exenteration of the orbit due to the extrascleral extension of malignant melanoma of the uvea is very rare, unfortunately, even today in certain cases it is necessary to make such a mutilating surgery. MATERIALS AND METHODS: Case report--65 year old female patient, sent to our Departement in 2008 with the finding of the pigment deposits on the posterior pole of the left eye. Ultrasound study found elevations of up to 3 mm, she was asked to come for further control in three months interval. She did not coma, furthermore she sporadically attended another eye clinic. In 2011 she was treated for secondary glaucoma--cyclocryopexia. Due to pain another surgery--tarzoraphia was indicated. In 2012 she underwent surgery at St. Elisabeth Cancer Institute in Bratislava--Nefrectomia transperitoneally l. dx., excision hepatis. Histological examination in addition to the primary papillary renal carcinoma--mucinous tubular T1 Nx Mx type, found the metastasis of malignant melanoma to the liver and right kidney. She underwent the diagnostic procedure to find the origo of the melanoma. The patient was subsequently admitted to our clinic with blind painfull eye for enucleation. During the surgery the was found retrobulbar tumor ingrowth. Histopatholigical findings confirmed malignant melanoma. Indicated was exenteration of the orbit due to malignant melanoma T4 N0 M2 stage in June 2012. After healing of the cavity she was recommended to design an individual prosthesis. After completing several courses of palliative chemotherapy during a recent review in January 2015 the patient is without recurrence of the melanoma in the orbit RESULTS: Histological examination confirmed malignant melanoma in stage G2, predominantly epithelioid type, spindle cell type in part B of pips, tumor fills the entire back and part of the anterior chamber, grows through the sclera and optic nerve is completely overgrown by tumor mass and spreads into orbit. The immunophenotype is suggesting a better prognosis (S100+, melanoma+, +HMB45, cyklin D1 3%, 10% of p53, Ki67 3%). Tissue eyelashes were infiltrated by numerous micrometastases. The patient after exenteration of the orbit after 3 months got an individual epithesis. Local orbit cavity is more than 24 months after exenteration without recurrence of melanoma. The patient is still undergoing outpatient chemotherapy and feels good. CONCLUSION: The treatment of malignant tumors of the orbit and the eye is difficult, in most cases surgical treatment is indicated, with the additional radiation therapy and chemotherapy. Malignant tumors at an advanced stage should to be solved radically. Exenteration of the orbit leads to produce a large defect in the orbit and this part of the face. Patients in the active age after surgery followed by facial defects after such procedures have disadvantage in work and thie defect leads to serious socio-economic challenges. Patients with individually made prosthesis comprising a refund of the eyeball and the surrounding soft tissues allow active life and full application of the private as well as professional life.

• MeSH
• eviscerace oka metody   MeSH
• lidé MeSH
• melanom patologie   chirurgie   MeSH
• nádory choroidey patologie   chirurgie   MeSH
• orbita chirurgie   MeSH
• protézy a implantáty * MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE: To present data pointing out that small tumour size might not be a sufficient predictor of good prognosis of choroidal melanoma and present a new promising therapy of hepatic metastasis. METHODS: Retrospective, noncomparative case report of two patients with small choroidal melanoma. RESULTS: Two cases of small choroidal melanoma which developed metastases are described. Both patients underwent radiotherapy of the primary tumour. Metastases were treated by combined therapy in patient 1 while in patient 2 a new therapeutic modality of stereotactic radiotherapy, Cyberknife, was applied. Patient 1 died from metastatic spread 7,6 years after primary therapy despite a very good local tumour control. Patient 2 died 11,3 years after primary therapy due to intercurrent disease with a very good local eye findings and hepatic metastasis in regression. CONCLUSION: Choroidal melanoma of a small size can develop into metastatic disease even long time after satisfactory primary treatment. Further studies are required to assess the risk factors of metastatic spread in small uveal melanomas. Cyberknife stereotactic radiotherapy seems to be a promising therapeutic method of a solitary hepatic metastasis. Key words: choroidal melanoma, metastasis, prognostic factors, stereotactic radiotherapy.

• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• fatální výsledek MeSH
• lidé MeSH
• melanom diagnóza   sekundární   chirurgie   MeSH
• metastázy nádorů MeSH
• nádory choroidey diagnóza   sekundární   chirurgie   MeSH
• nádory uvey diagnóza   sekundární   chirurgie   MeSH
• následné studie MeSH
• radiochirurgie metody   MeSH
• uveální melanom MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: Course of progression of the malignant choroidal melanoma diagnosed in T2 stage up to stage T4 with infiltration of the orbit. Case report 41 year old patient identified with intraocular malignant melanoma in the year 2005, documentation of disease progression and disease. Access to treatment of intraocular malignant melanoma in stage T1 - T2 in the last decade has changed from a radical approach (enucleation) towards conservative treatment (brachytherapy, radiosurgical methods) or combined procedures (pars plana vitrectomy and endoresection followed by irradiation or addition of laser treatment). Currently, more than 60% of uveal melanoma is treated by brachytherapy or radiosurgical techniques and combined procedures. CASE REPORT: A 41 years old female patient with malignant melanoma in the choroid stage T2 since 2005. The volume of the tumor was 0.9 cm³, maximal elevation was over 12 mm. The patient refused a radical treatment (primary enucleation). Due to the stage of the melanoma she was recommended to stereotactic radiosurgery and combined therapy. She underwent stereotactic radiosurgery (TDmax - total dose of 35.0 Gy) in 2005. In 2006 pars plana vitrectomy with incomplete endoresection of the tumor and silicon oil instillation was done. In 2006-2007 appeared bleeding into the anterior chamber and she underwent three times an anterior chamber lavage in another department with subsequent development of secondary glaucoma. In January 2010 patient came to our department with the local finding of malignant melanoma in stage T4 with epibulbar growth process and the infiltration of the orbit. In the period have been found two solid liver metastases. Indicated exenteration of the orbit, histopathologically confirmed mixed cell type malignant melanoma. CONCLUSION: Progression of malignant melanoma after incomplete endoresection despite previous radiosurgical treatment can be very rapid in the course of the disease documented by ultrasound, computed tomography and magnetic resonance. The patient subsequently passed to another workplace and underwent repeated lavage of the vitreous cavity. During endoresection is opened the package fibrous mesh gateway for the infiltration process in the cavity of the orbit and epibulbar space. In the case of residual melanoma after endoresection even though the tumor was irradiated before the procedure the melanoma might progress very fast into the surrounding tissues.

• MeSH
• dospělí MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• melanom farmakoterapie   patologie   chirurgie   MeSH
• nádory choroidey farmakoterapie   patologie   chirurgie   MeSH
• radiochirurgie * MeSH
• skléra patologie   MeSH
• vitrektomie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: Comparison of two methods of irradiation of patients with malignant choroidal melanoma - stereotactic radiosurgery and proton beam irradiation. External (non-contact) applied irradiation is used as a source of accelerated protons, respectively helium ions. This method allows applications of ionizing irradiation also despite the low radiosensitivity of cells of malignant melanoma of the uvea (MMU). External source of ionizing radiation is modulated current energy electrons, protons or neutrons, accelerated in linear accelerators. From the external medium voltages resources (4-16 MeV) are irradiated tissues with target dose of 5.0-24.0 Gy. Volume protons permeate straight the structures of the eye to a certain distance. The use of proton radiation density of ionized protons increases in the vicinity of the impact due to energy losses for electrons interacting with the environment. At the end of the track there is a huge increase in the ionization dose ("Bragg spike"). Therefore, the structures surrounding the eye at the point of entry and little affected and increasing the dose at the end of the proton beam is ideal for the desired therapeutic effect. Fractionated application is also possible. CASE REPORT: In December 2011 we performed stereotactic radiosurgery to treat female patient (born 1939) with malignant melanoma of the choroid stage T1 N0 M0. Plan has been drawn up for stereotactic irradiation - model for linear accelerator Clinac, Corvus planning system ver. 6.2, verification and OmniPro IMRT planning system Liebinger ver. 4.3. Patient characteristics were compared with the virtual plan for proton radiation therapy, and we used the scheme in Physical parameters FIAN-technical center in the Russian Federation. We compared both planning protocols and assess in particular the extent of radiation surrounding non-tumor tissue. RESULTS: When comparing the two planning schemes irradiation levels of surrounding tissues and risk structures (lens, optic nerve, chiasm) in both methods were corresponding to the required standard. CONCLUSION: Treatment of uveal melanoma through proton beam irradiation in Slovakia is not available yet, although it has several advantages, such as fractionation and the possibility of achieving a higher dose of irradiation to deposit (more than 50.0 Gy). The fundamental difference between the two methods for an eye is particularly the possibility of proton beam irradiation exposure of tumor of iris and ciliary body, which can not be solved through stereotactic radiosurgery. The dose to the tumor during irradiation can be optimized. The model device allowed us to make OPTMI - Therapy (Proton Treatment with Optimized Modulated Intensity).

• MeSH
• lidé MeSH
• melanom radioterapie   chirurgie   MeSH
• nádory choroidey patologie   radioterapie   chirurgie   MeSH
• plánování radioterapie pomocí počítače * MeSH
• protonová terapie * MeSH
• radiochirurgie * MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• srovnávací studie MeSH

There was a 10-years anniversary from the introduction of photodynamic therapy (PDT) with verteporfin in the Czech Republic recently. We still follow one of our first patients with neovascular macular degeneration. Although it was possible to stabilize the vision of the better eye almost 3 times longer compare to a natural history of the disease on the fellow eye, the final result on both eyes today is identical and below the legal blindness range.We use PDT as a monotherapy for example in management of choroidal hemangioma now-a-days as two next cases show. There were lesions localized peripapillary and bigger than the maximum laser spot size respectively. So called "floating spot" was performed--principle of which we had published previously elsewhere.

• MeSH
• fluoresceinová angiografie MeSH
• fotochemoterapie * MeSH
• hemangiom diagnostické zobrazování   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• makulární degenerace diagnóza   farmakoterapie   MeSH
• mladiství MeSH
• nádory choroidey diagnostické zobrazování   farmakoterapie   MeSH
• neovaskularizace choroidey diagnóza   farmakoterapie   MeSH
• porfyriny terapeutické užití   MeSH
• senioři MeSH
• ultrasonografie MeSH
• verteporfin MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• porfyriny MeSH
• verteporfin MeSH